Exam 1 Flashcards by Tim Jones

What are the levels of Care as defined in the PCC guidelines?

Tier 1: All Service
Tier 2: CLS certified
Tier 3: Combat medic/corpsmen (CMC)
Tier 4: Combat Paramedic/ Provider (CPC)

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Roles of care as defined in PCC

1A Ruck: 1 hour
1B Truck: 1-4 hour
1C House: 4 hours or more
1D Plane: no timeframe

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What treatment algorithm do the PCC guidelines follow and what do the letters stand for?

M - Massive Hemorrhage
A - Airway
R - Respiration and Ventilation
C2 - Circulation and Resuscitation
H3 - Hypothermia, Hyperthermia, Head injury
P - Pain Management
A - Antibiotics
W - Wound care and nursing
S - Splinting, Fractures, Burns
L - Logistics

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What is the difference between the POI TCCC AAR Form and the TCCC PI Data Form?

AAR is filled out as part of the AAR - includes treatments and who administered, comments, sustains and improves for each casualty in the BAS.

PI DATA - filled out during or after to capture difficulties and guide AAR.

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Why is the DD 3019 not recommended for use in a Role 1 facility?

Focused on nursing and physician level care in Role 2’s or higher

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What is the purpose of the DOD ADVISOR Line?

Allows consult from providers outside of your immediate area.

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What form is the basis for PCC Care?

TCCC Card, DD1380

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What are some of the benefits of the Prolonged Field Care Casualty Card?

Designed to help guide during PCC and is fully customizable.

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What are some factors that can affect accuracy of lab results?

Hydration status, Drugs, Medical Conditions.

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Urine Dipstick tests produce results in ______

30 - 120 seconds

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What are unique features of the i-STAT?

11 steps to printed results
dry chemistry analyzer
5-6 minutes hands-on time
4-month expiration date
cartridges must be room temperature

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What are unique features of the Piccolo Express?

3 easy steps
Reference grade “wet chemistry”
30 seconds of hands-on time
12 months or longer expiration date
Discs can be used from refrigerator

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What are the lab values assessed in CBC (complete blood count)?

White Blood Cell Count (WBC) 5.0 - 10.0

Hemoglobin (HgB) Male 14 - 18g/dL & Female 12 - 16g/dL

Hematocrit (Hct) 41 - 50%

Platelet Count (PCT) 150,000 - 400,000 mm3

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Describe the relative results of blood loss

< 15% blood loss = slight heart rate elevation but normal
15-30% = slight increase of pulse/resp above, narrowing pulse pressure
30-40% blood loss = Noticeably weak, intermittent radial pulses
> 40% blood loss = leading to organ failure or death

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What are the Fluid Resuscitation options from Most to Least Preferred?

Whole Blood
Plasma, RBC, Platelets in 1:1:1 Ratio
Plasma, RBC, in 1:1 Ratio
Plasma or RBC alone
Crystalloids (LR / Plasma lite)

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What Lab Values are assessed in a Basic Metabolic Panel (BMP)?

Bicarbonate (HCO3-)
Chloride (CI-)
Blood Urea Nitrogen (BUN)
Potassium (K+)
Sodium (Na)
Creatine (Cr)
Glucose (Glu)
Calcium (Ca)

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Describe TXA Administration According to Current TCCC Guidelines

*2 grams TXA, slow IV or IO push ASAP / no later than 3 hours.

Likely to need blood transfusion due to presentation of hemorrhage shock

More than 1 amputation or penetrating torso trauma

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Describe Calcium Administration

1 gram Calcium after giving the first unit of blood (30ml of 10% Calcium Gluconate)
10ml of 10% Calcium Chloride

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Assessing for a Response

Responder - clinical and objective trends improves after resuscitation and remains stable.

Transient Responder - improves after resuscitation but then declines.

Non Responder - does not improve.

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What is the order of priority when considering donors in blood collection?

A. prescreened within the last 90 days, full panel of FDA licensed donor infectious diseases, negative on all tests.
B. prescreened between 90 to 365 days, full panel of FDA licensed donor infectious diseases, found negative for all tests.
C. donors report being repeat blood donors in the past have not been differed to transfusion transmitted disease.
D. donors who have not been prescreened with FDA tests nor have they donated in the past.

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List the blood types and the antigens they each contain.

Type A - only contain A antigen
Type B - only contain B antigen
Type AB - contain both A/B antigen
Type O - has neither A or B antigen

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Describe the compatibility between different blood types that consist of Rh - or Rh +

Rh+ can receive either Rh+ or Rh-
Rh- can receive Rh+ once
Rh- can be given Rh+ blood; likely produce Rh+ antibodies
*if unborn child Rh+= hemolytic disease

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What chart calculates initial TBSA burns in adults?

Wallace Rule of 9’s Burn Wound Chart

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A casualty has burns to the posterior bilateral legs and lower torso. What is the % TBSA?

27%

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What chart is the most accurate for calculating burns in children or adults? And when is it mainly used?

- Lund and Browder wound chart - After irrigation and debridement of dead eschar tissue after initial TBSA has been calculated.

What routes, other than IV/IO may be used for fluid resuscitation in burn casualties with less than 30% TBSA burns?

Rectal Orogastric Nasogastric

What are the fluids of choice for IV/IO route?

Lactated Ringers / Plasma Lite

What criteria determines if you should initiate the Rule of 10's?

2nd and 3rd degree burns covering more than 20% TBSA

How often should a patient's vitals be monitored initially?

Every 15 minutes

How often should a patient's vitals be monitored once stable?

30-60 minutes for more than 2 hours

What is the hourly goal for urinary output and why is it important to know this?

goal is 30 to 50mL every hour urine output is a main indicator of resuscitation adequacy in burn shock

What are some methods for measuring Urine Output?

Foley catheter Graduated cylinder Adjust IV rate

If UOP is too low or too high, what actions should you take?

too low: INCREASE by 25% of fluid base too high: DECREASE by 25% of fluid base within range: DO NOTHING

What is the goal of an Escharotomy?

To prevent and manage swelling of burned tissue to prevent long term damage

How is an Escharotomy different from a Fasciotomy?

Only the burned tissue is divided in Escharotomy; not the fascia Escharotomy - Shallow cuts Fasciotomy - Deep cuts

Why is it a good idea to avoid wet dressings on a burn casualty?

to prevent hypothermia

How much fluid would you recommend packing considering 72 hour delayed evacuation?

28 liters total Day 1 = 16 liters Day 2 = 8 liters Day 3 = 1/2 4 liters

Indications for a foley catheter

Urinary retention Monitoring of urine output Drainage of bladder (if not able to drain itself) Obtaining uncontaminated urinated specimen Measure residual urine in bladder Dilate urethral structure

Contraindications for a Foley Catheter

Urethral disruptions due to pelvic trauma Acute Urethral or prostate infection

Signs of Urinary Infection

Chills Fever Back/Flank pain Hematuria (blood in urine) Cloudy/foul smelling urine

What should you educate a patient on after Foley Removal

Explain - there will be mild burning or discomfort when voiding. Notify - Urgency, Acute burning, Frequency, Pain/Discomfort.

What blood product was approved as the universal blood product for resuscitation of exsanguinating hemorrhage?

Low Titer Whole Blood (LTOWB)

Involves burn damage to epidermis and into a variable depth of the dermis but not the underlying tissue.

2nd Degree Burn

Burns with a dry, pearly white or waxy appearance.

3rd Degree Burn

Minor tissue damage to epidermis layer only

1st Degree Burn

What are the differences between Stored Whole Blood and Fresh Whole Blood?

SWB is FDA approved, tested and stored. Transmitted disease free, preferred at prehospital because of its low titer. FWB collected in emergency, to be used in 24 hours or stored in 8 hours. Hemostatic function, no lesions and used as a last resort.

A wound resulting in a sort of flap

Avulsion

A deep cut or tear in the skin

Laceration

What are the max doses for 1% or 2% lidocaine with or without epinephrine?

3mg/kg without epinephrine 7mg/kg with epinephrine

If using ketamine, what medication and dose is used in conjunction for a synergistic effect?

Non-intubated: Midazolam -0.5 - 2mg every 5 minutes until goal is achieved Intubated: 1-4mg

For a large wound, how much fluid and what technique should be used for best results?

Large bag of IV fluids connected to IV tubing. Pour over 9 liters onto wound while scrubbing.

What are the 4 C's that should be used to determine tissue viability?

i. Color ii. Contraction iii. Consistency iv. Circulatory

What types of hemorrhage control should be considered before starting debridement?

Combat gauze Clamps Ligation Electrocautery

Besides keeping the wound slightly moist what additional benefit does Wet-to-Dry dressing provide?

Mechanical Debridement

If you do not have a KCI wound V.A.C., what instruments could you use to create a negative pressure effect for an open wound?

Gauze, Tegaderm, Loban (coban)

What antibiotic would provide the best coverage in a tropical environment?

Levofloxacin

What is Dakin's solution used for?

as an antiseptic that kills most forms of bacteria, viruses, and fungi

What is the best practice for deep wound dressing?

Negative Pressure Wound Therapy

Small wounds typically require which size suture?

2-0 3-0 / 4-0 can also be used for face

Fill in the blanks. a. ____ all items for exp and viability b. Add sterile items without ______. c. Do not ____ inner cap or opening without sterile gloves of sterile solutions. d. For best sterile withdrawal, a _____ is preferred.

a. Inspect b. Contamination c. Touch d. Assistant

What other methods of primary closure are there besides sutures?

Cyanoacrylate (dermabond) or skin staples

What are the suture removal time frames for; a. Face b. Scalp c. Chest, extremities d. High tension areas, joint, back

a. 4 or 5 days b. 7 days c. 10 to 14 days d. 14 to 21 days

Per TCCC guidelines what are the MINIMUM and BEST interventions to be performed for hemorrhage control?

Minimum: Limb tourniquets, Wound packing, Pressure dressing, Hemostatic dressing, Junctional tourniquets, Pelvic binders Best: AAJT, REBOA

What is the SBP Goal if resuscitating with blood products? What if you are unable to resuscitate with blood products? With a TBI what is the SBP Goal?

- with blood products: 100mmHg - unable to with blood products: 80-90mmHg - in TBI: greater than 110mmHg

What are the end points of resuscitation?

Clinical Stabilization: slowing heart rate improved peripheral pulses (cap refill) warming extremities mental status improvement (non TBI) Improved vital signs and objective criteria: Systolic BP at goal SpO2 > 92% FiO2 Required < 50% Temp > 95% Urine output > 30ml/h

What are the common causes of elevated and diminished levels of Hematocrit (Hct). *also what is the standard range?

Elevated: burns, eclampsia, severe dehydration. Diminished: bone marrow failure, hemorrhage, high altitude

What are the common causes of elevated and diminished levels of Hemoglobin (Hgb)? *also what is the standard range?

Elevated: severe dehydration (or hemoconcentration), severe burns, high altitude. Diminished: hemorrhage, nutritional deficiency, renal disease, RBC destruction

What are the common causes of elevated and diminished levels of White Blood Count (WBC)?

Elevated: infection, trauma, surgery stress/pain, smoking, chronic inflammation, medication-induced, sepsis Diminished: viral infection, bacterial infection, autoimmune disease, hepatitis, sepsis

What effect does adding epinephrine to the administration of lidocaine have?

adding epinephrine increases the duration of effect by constricting the surrounding vessels.

What is proctoclysis?

rectal infusion

Exam 1 Flashcards

(71 cards)